title: Effect of age and early intervention with a systemic steroid, intravenous immunoglobulin or amniotic membrane transplantation on the ocular outcomes of patients with Stevens-Johnson syndrome.
abstract: OBJECTIVE
  This retrospective observational case series of fifty-one consecutive patients referred to the eye clinic with acute-stage Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) from 1995 to 2011 examines the effect of early treatment with a systemic corticosteroid or intravenous immunoglobulin (IVIG) on the ocular outcomes in patients with SJS or TEN.
  
  
  METHODS
  All patients were classified by age (≤18 years vs. >18 years) and analyzed by treatment modality and early intervention with systemic corticosteroids (≤5 days), IVIG (≤6 days), or amniotic membrane graft transplantation (AMT) (≤15 days). The main outcomes were best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR) and ocular involvement scores (OIS, 0-12), which were calculated based on the presence of superficial punctate keratitis, epithelial defect, conjunctivalization, neovascularization, corneal opacity, keratinization, hyperemia, symblepharon, trichiasis, mucocutaneous junction involvement, meibomian gland involvement, and punctal damage.
  
  
  RESULTS
  The mean logMAR and OIS scores at the initial visit were not significantly different in the pediatric group (logMAR = 0.44, OIS = 2.76, n = 17) or the adult group (logMAR = 0.60, OIS = 2.21, n = 34). At the final follow-up, the logMAR and OIS had improved significantly in the adult group (p = 0.0002, p = 0.023, respectively), but not in the pediatric group. Early intervention with IVIG or corticosteroids significantly improved the mean BCVA and OIS in the adult group (p = 0.043 and p = 0.024, respectively for IVIG; p = 0.002 and p = 0.034, respectively for corticosteroid). AMT was found to be associated with a significantly improved BCVA or OIS in the late treatment group or the group with a better initial OIS (p = 0.043 and p = 0.043, respectively for BCVA; p = 0.042 and p = 0.041, respectively for OIS).
  
  
  CONCLUSIONS
  Our findings suggest that patients with SJS or TEN who are aged 18 years or less have poorer ocular outcomes than older patients and that early treatment with steroid or immunoglobulin therapy improves ocular outcomes.
authors.affiliation: Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea. ; Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea.
authors.forename: Kyeong Hwan
authors.initials: KH
authors.lastname: Kim
authors.forename: Sung Wook
authors.initials: SW
authors.lastname: Park
authors.forename: Mee Kum
authors.initials: MK
authors.lastname: Kim
authors.forename: Won Ryang
authors.initials: WR
authors.lastname: Wee
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000367:Age Factors; D000650:Amnion / Q000637:transplantation*; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003316:Corneal Diseases / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000150:complications / Q000473:pathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous
keywords: Amniotic membrane graft transplantation; Immunoglobulins; Ocular complication; Steroids; Stevens-Johnson syndrome